Burn injury: burn service referral?
Do the primary survey (ABCDE) first. Treat airway, breathing and shock before the referral decision.
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Plastic SurgeryDiagnostic
Burn Service Referral and Transfer Criteria (ANZBA/ABA)
Burn Service Referral and Transfer Criteria (ANZBA/ABA): Burn injury: burn service referral? → Airway burn or inhalation injury: secure the airway early...
Pathway Overview
13 steps
Algorithm Steps
13 total
01Start 02Warning Airway burn or inhalation injury: secure the airway early
Airway swelling can get worse quickly, also during transfer. SpO2 can read normal in carbon monoxide poisoning: check carboxyhaemoglobin on a blood gas.
- Signs: enclosed-space fire, facial burns, sooty sputum, stridor, hoarse voice, respiratory distress
- Give humidified 100% oxygen; think of carbon monoxide and cyanide poisoning
- Get senior airway help; consider intubation before transfer
03Action First aid: cool running water for 20 min
Start as soon as possible; it helps up to 3 h after the burn. Remove clothing and jewellery. No ice.
- Young children and large burns: risk of hypothermia. Cool smaller areas in turn, pause if needed, keep the patient warm
- Dry chemical powder (for example lime): brush it off before water, then irrigate
- Hydrofluoric acid: needs calcium gluconate and monitoring for low calcium and arrhythmia; get Poisons Information advice at once
- Chemical in the eye: irrigate at once and continuously; discuss with ophthalmology
- Other chemical burn: irrigate with water; call Poisons Information Centre 13 11 26
- No running water: cool wet cloths, changed often
04Action Size and depth: refer if any
Estimate TBSA with the patient's palm (about 1%) or the Rule of Nines. Child: use a paediatric (Lund and Browder) chart, not the adult Rule of Nines. Do not count superficial (red, unblistered) skin.
- Adult: burn >10% TBSA
- Child: burn >5% TBSA
- Full-thickness burn >5% TBSA
- Any full-thickness or possibly deep burn: discuss with the burn service
05Action Special areas: refer if any, even if small
- Face, hands, feet
- Genitalia, perineum
- Major joints
- Circumferential burn of a limb or the chest
06Action Mechanism: refer if any
- Inhalation injury, suspected or confirmed
- Electrical burn, including lightning (see the electrical warning next); consider spinal precautions
- Chemical burn
07Warning Electrical injury, including lightning: hidden muscle damage
The skin burn underestimates the injury. Fluid needs are higher than the TBSA formula shows. Refer all electrical burns.
- ECG and cardiac monitoring; consider 24 h monitoring. Look for entry and exit wounds
- Check CK and urine for pigment (pink to dark red)
- Pigmented urine: increase IV fluids for urine output 75-100 mL/h (adult); child: burn service advice
08Action Patient factors: refer if any
- Pregnancy
- Pre-existing illness
- Associated major trauma
- Extremes of age: young children (all infants <12 months) and the elderly
- Suspected non-accidental burn: also follow the local child or adult protection process
- Care needs beyond this hospital, or pain not controlled
09Decision Any referral criterion met?
One criterion is enough. If unsure, discuss with the burn service.
- If Yes
- Any met
10Action Criterion met: refer to the burn service now
Call the state adult or paediatric burn service; they decide clinic review or transfer. For transfer, call the retrieval service. Major burn (adult >20% TBSA, child >10% TBSA), electrical injury or unstable patient: stabilise as below.
- Airway secure; oxygen on
- 2 large-bore IV cannulae; intraosseous or central access if needed
- Adult >20% TBSA or child >10% TBSA: start burn fluid resuscitation (modified Parkland) with burn service advice. Electrical injury: start fluids even if the skin burn is small
- Urinary catheter; urine output target: adult 0.5-1 mL/kg/h, child <30 kg 1 mL/kg/h. Pigmented urine after electrical injury: adult 75-100 mL/h
- IV opioid analgesia, titrated to pain score
- Major burn: nasogastric tube
11Action Before transfer: wounds, warmth, checks
- Cover burns with cling film laid lengthways; do not wrap round a limb; not on the face or a chemical burn
- Transfer delayed more than 6 h: ask the burn service which dressing to use
- Keep the patient warm; elevate burnt limbs
- Circumferential burn: check distal perfusion and chest movement; discuss escharotomy with the burn service
- Tetanus prophylaxis as indicated
- Send documentation; tell next of kin
12End Transfer to the burn service
Complete the transfer checklist with the burn and retrieval services.
If No- None met
13End No criterion met: manage locally
Never for electrical, chemical or inhalation injury, or a suspected non-accidental burn: these always need referral. Minor burn care per local or state guideline; review in 24-48 h. Refer if the burn is not healed by 14 days, gets infected or gets worse, or if size or depth is uncertain.
Guideline Source
ANZBA Burn Referral Criteria; ABA Guidelines for Burn Patient Referral (2022)
Clinical Safety Information
Clinical Decision Support — Not a Substitute for Clinical Judgment
Individual patient factors may require deviation from these recommendations.
Known Limitations
- Referral criteria only: the burn service and retrieval service decide the transfer plan
- No fluid volumes or drug doses: use EMSB or state burn service guidance
- Referral thresholds are ANZBA and ABA; UK and European thresholds differ
Applicable Regions
AUNZUS
AU: Use ANZBA referral criteria; refer through the state adult or paediatric burn service
NZ: Use ANZBA referral criteria; refer to the regional burn unit
US: ABA Guidelines for Burn Patient Referral (2022): immediate consultation for full-thickness burns, partial thickness >=10% TBSA, deep burns of special areas, comorbidities, trauma, poorly controlled pain, inhalation, chemical, high-voltage electrical and lightning injury. Poison Control 1-800-222-1222
Version 2Next review: 2027-09-30
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Related Resources
Frequently Asked Questions
What is the Burn Service Referral and Transfer Criteria (ANZBA/ABA)?
The Burn Service Referral and Transfer Criteria (ANZBA/ABA) is a diagnostic clinical algorithm for Plastic Surgery. It provides a structured decision tree to guide clinical decision-making, based on ANZBA Burn Referral Criteria; ABA Guidelines for Burn Patient Referral (2022).
What guideline is the Burn Service Referral and Transfer Criteria (ANZBA/ABA) based on?
This algorithm is based on ANZBA Burn Referral Criteria; ABA Guidelines for Burn Patient Referral (2022).
What are the limitations of the Burn Service Referral and Transfer Criteria (ANZBA/ABA)?
Known limitations include: Referral criteria only: the burn service and retrieval service decide the transfer plan; No fluid volumes or drug doses: use EMSB or state burn service guidance; Referral thresholds are ANZBA and ABA; UK and European thresholds differ. Individual patient factors may require deviation from these recommendations.
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